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Why health care institutions need to build trust with the Black community in the fight against the pandemic

Bria Hamilton is a Master’s student in the Environmental Studies program at York University in the Urban Planning stream. Her research is focused on Black feminist geographies and the use of these theories to disrupt normative planning practices.

Bria also works with CSI on the Every One Every Day: Toronto program as a Neighbourhood Asset Mapping Researcher. This op-ed was originally published in The Globe and Mail. We’ve republished with Bria’s permission.

“I don’t want to get the vaccine.” I have heard variations on this sentiment numerous times from my Black friends and family members regarding the incoming COVID-19 inoculations. In this specific instance, it was my Jamaican-born grandmother, who has lived in Canada since 1974.

I set aside my initial discomfort surrounding anti-vaccination rhetoric, which often cites unfounded side effects of vaccines. After I asked my grandmother why she felt this way, she hesitated before telling me that she did not trust the vaccine, she was not sure how it worked and she felt the trial phase was too quick. She had heard from her friend that multiple people had died from the trials; her friend had heard this information from their friend, and so on.

My grandmother, my mother and I have all had extremely negative experiences with Canadian medical care. The most atrocious story was the removal of my grandmother’s uterus without her permission during unrelated surgery.

These stories of medical racism are commonly shared within and across Black communities, many of whose members do not trust medical institutions to care for us. This mistrust is certainly not unfounded: the histories of Canada and the United States are riddled with enslavement, institutionalized racism and over-policing of Black bodies.

The Tuskegee Study in the United States has become a widely known exemplification of medical anti-Black racism. From 1932 until the study was disclosed in 1972, hundreds of Black men in Tuskegee, Ala., were purposely withheld syphilis treatment by the U.S. Public Health Service in order for researchers and practitioners to study the natural course of the disease.

The patients believed they were receiving standard treatment but instead were “subjected to blood draws, spinal taps, and eventually autopsies” by white medical staff, Marcella Alsan and Marianne Wanamaker wrote in The Quarterly Journal of Economics in 2018.

The majority of the patients in the study died as a result of the disease and lack of treatment. The Tuskegee Study cemented existing oral histories and generational knowledge of racist medical practices, and it is marked as a major contributor to medical distrust in Black communities.

Entrenched memories, oral histories and traumas of medical abuse are often dismissed as conspiracy theories amongst broader populations, as J.M. Hoberman noted in his book Black and Blue: The Origins and Consequences of Medical Racism. Despite the widespread tendency to dismiss experiences of medical racism, there are clear indicators of inadequate health care for Black people.

For centuries, medical professionals have sought to prove biological differences between Black people and white people and their tolerance for pain. According to a 2016 study presented at the U.S. National Academy of Sciences, as many as 50 per cent of white doctors still believe that biological differences allow Black people to tolerate more pain, and thus provide inaccurate medical recommendations for those patients. A study published in the Journal of Perinatal Education found Black Americans are up to six times more likely to die of pregnancy-related complications than white women.

Canada neglects to collect race-related health care data at all, but with the maintenance of oral histories in Black communities, the medical mistrust persists.

The effects of COVID-19 are contextualized within a historically racist system and thus exacerbate disenfranchisement in racialized communities. Marginalized communities are most susceptible to the virus because of high-density dwellings; the necessary use of shared spaces; the fact that low-income workers are required on the front lines; and the use of public transit.

COVID-19 infections are continuing to rise in Canada and the United States, and the Black population has been overrepresented in these cases. Black people in Toronto, for instance, represented 9 per cent of the population but made up 21 per cent of the reported COVID-19 cases, as outlined by Dr. Eileen de Villa, the city’s Medical Officer of Health in July, 2020.

The COVID-19 vaccines will serve as an essential measure of combatting the virus. Despite the necessity of the vaccine in Black communities, which increasingly face the negative effects of the virus, health care and government organizations have neglected to consider the mistrust of institutions amongst Black people. At a press conference in December, Ontario’s Health Minister Christine Elliott mentioned that those who choose not to be vaccinated may face restrictions when travelling and within communal spaces, such as movie theatres.

With the possibility of these restrictions, I am heavily concerned that the inaccessibility of health care and the warranted medical distrust within Black communities will result in additional discrimination and immobility for Black people. Governing and health care bodies are responsible for this mistrust and thus are responsible for providing avenues through which Black people can feel comfortable and safe receiving COVID-19 vaccines.

To achieve this, I recommend extensive work into collaborative efforts toward vaccine education within Black communities, as well as continuing anti-racism education for health care practitioners.

Within my field – urban planning – public consultations allow community members to ask questions, develop relationships and ultimately build trust toward planners who aim for healthier communities. In the medical field, community engagement frameworks can be used for educational and collaborative efforts, and can help lead to safer medical experiences for Black people. The process of creating vaccines should be explicitly showcased with attention paid to accessible, culturally relevant information.

In light of international attention to George Floyd’s killing, many institutions, governments and organizations have put forth statements about the need to address anti-Black racism. In Canada in particular, racism discourse is sidelined by the hegemonic self-proclamation of a diverse and inclusive nation. Anti-Black racism work requires more than statements: There needs to be action, trust-building efforts, anti-racism education and the active engagement of Black voices in these conversations.

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